MEDICARE: KARINA MARIANA LAISSAOUI BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	7157

General Provider Information

NPI Number	:	1992211924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARINA MARIANA LAISSAOUI BCBA

Provider Business Mailing Address
First Line	:	905 ROBERTS CUTOFF RD
Second Line	:
City	:	RIVER OAKS
State	:	TX
Zip	:	76114-2825
Country	:	US
Telephone Number	:	325-227-3885
Fax Number	:

Provider Business Practice Location Address
First Line	:	905 ROBERTS CUTOFF RD
Second Line	:
City	:	RIVER OAKS
State	:	TX
Zip	:	76114-2825
Country	:	US
Telephone Number	:	325-227-3885
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2017
Last Update Date	:	07/16/2024

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